Should Doctors Help With Executions? No Easy Ethical Answer

By ADAM LIPTAK

Published: June 10, 2004

ATLANTA, June 7—
Dr. Sanjeeva Rao used to look after the inmates at the state prison in Jackson, Ga., treating their high blood pressure and more serious ailments. When the state started using lethal injections in 2000, he took on another task: helping to execute them.

Dr. Rao does not administer the injections, but he monitors the process, and occasionally, he has testified, he helps out. If the prisoner's heart monitor has not flatlined after the injections meant to kill him, Dr. Rao orders up more poison.

In 2001, after a nurse spent 39 fruitless minutes stabbing needles into Jose High, a former drug addict, in search of a sound vein, Dr. Rao put in a line through his neck that allowed the deadly chemicals to flow.

''I always say 'a patient,''' he testified in a 2002 case filed by a death row inmate that unsuccessfully challenged lethal injections as inhumane. ''That's by habit.''

Doctors who participate in executions violate the most fundamental tenet of medical ethics, some critics say. But others defend these doctors, saying that lethal injections, the almost-universal form of execution in the United States, can be performed humanely only by medical professionals.

Dr. Sidney Wolfe, the director of health research for the consumer advocacy organization Public Citizen, said Dr. Rao and others like him should be disciplined. ''The state medical boards should just yank the licenses of these people,'' Dr. Wolfe said.

Dr. Kenneth Baum, the author of a law review article on the question, disagreed, saying that doctors can play a valuable role at executions. The alternative, he said, is having prison employees with little training perform the procedures.

''In the absence of competent medical oversight,'' Dr. Baum said, ''many of these executions are unnecessarily painful. There is no reason, given that we are going to execute these people, to leave them defenseless.''

About 25 states allow or require doctors to be present at executions. But information on the number of doctors who participate in executions is hard to come by, as states generally refuse to name anyone who does so, citing security and privacy concerns. The Georgia Department of Corrections, for instance, says execution records are ''privileged and confidential state secrets.''

Dr. Rao's name was disclosed in the 2002 lawsuit challenging Georgia's use of lethal injections. He did not respond to several messages left at his office and his home seeking comment.

Many of the states that encourage doctors to participate in executions have seemingly contradictory laws that allow doctors to be disciplined by state medical boards for violating codes of medical ethics. Those codes almost universally forbid participation in executions.

The American Medical Association's ethics code, for instance, says that ''a physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution.''

''They're not allowed to determine that the execution has been unsuccessful so that the execution can be repeated,'' said Dr. Stephen H. Miles, a professor of medicine at the University of Minnesota and author of ''The Hippocratic Oath and the Ethics of Medicine.''

But a survey of doctors in 2001 found that more than 40 percent would be willing to perform at least one of the forbidden activities.

Scholars who have studied the matter said they knew of no state board action against a doctor for aiding in a lawful execution.

Dr. Arthur Zitrin, a retired professor of psychiatry at New York University and a former director of psychiatry at Bellevue Hospital, aims to change that.

''My major thrust,'' he said, ''is to identify physicians who have participated in executions in one way or another, with the objective of charging these physicians with professional misconduct for violating medical ethics.''

Dr. Zitrin tried to have Dr. Rao expelled from the American College of Physicians, an internists' organization. The effort failed when the group determined that Dr. Rao was behind in his dues and was thus no longer considered a member.

Dr. Zitrin said he and two Georgia lawyers, Michael Mears and Matthew Rubenstein, would file a complaint against Dr. Rao with the Georgia medical authorities this month. ''I'm also on the trail of a doctor in Virginia, and one in Illinois,'' he said.

The question of whether doctors should participate in executions is more difficult now that lethal injections are the dominant mode of execution in the United States. Firing squads and electric chairs did not require doctors to help in quite the same way, medical experts say.

''What's unique about this procedure is that it's specially designed to imitate medical procedures,'' said Dr. Jonathan I. Groner, a surgery professor at Ohio State University and the trauma medical director of the Columbus Children's Hospital .

In a unanimous decision on May 24 allowing a death row inmate to challenge lethal injections as cruel and unusual punishment, the United States Supreme Court appeared to suggest that a doctor should be required for at least some procedures.

The inmate in that case, David L. Nelson, had badly damaged his veins by long-term drug use, and went to court to fight a plan by Alabama prison officials to make a two-inch incision in his arm or leg to allow his execution to proceed. ''There was no assurance,'' Justice Sandra Day O'Connor wrote in the decision, ''that a physician would perform or even be present for the procedure.''

At least eight states, including Georgia, also seek to shield doctors from professional discipline through laws saying that aiding in executions is not the practice of medicine.

Dr. Baum, who supports letting doctors participate in executions, said such laws are dishonest.

''What about this is not the practice of medicine?'' he asked. ''It's inserting the I.V.; it's infusing medicine; it's monitoring vital signs; it's declaring death. These are practices that in any other setting are the practice of medicine.''

Some of those opposed to allowing doctors to participate in executions concede that their real agenda is abolition of the death penalty.

''It is true that this is my small way to get at an abhorrent process,'' Dr. Wolfe of Public Citizen said.

Others say it is possible to oppose the death penalty and approve of doctors aiding in executions.

''The physician's role is to treat when you can and to comfort when that is all you can do,'' Dr. Baum said. ''I wouldn't see any conflict in a physician who participates in executions being vocally anti-death-penalty. There's not a conflict in my mind, ethically, morally or politically.''

Photo: Dr. Arthur Zitrin is a New York doctor who is trying to bring disciplinary charges against doctors who participate in executions. (Photo by James Estrin/The New York Times)